People's Republic of America

I took my minivan to the local car wash the other day.  As the song goes, it never rains in Southern California, but the air is thick with dust and smog so a car wash is still de rigeur every couple of weeks.  I pulled into one of the stalls where they take your order for the kind of wash you want.  There are five choices listed, from "economy" to "deluxe".  I normally go with "economy" but since company was coming over, I decided to splurge a little and chose "standard".  With this package they even asked me what scent air freshener I wanted. After the car came out of the wash, several guys swarmed the car to dry and polish.  This was more attention than my usual cheapo car wash. I have these complicated multispoke wheels on the car that they normally just wipe over.  Not today. They were polishing each spoke individually. Man did the old minivan look sharp.  They even got the dirt that collects under the wind deflector on the rear door.  I should live a little and get this wash more often.

So how does this anecdote relate to health care?  It's all about the choices almost all businesses offer but not in medicine.  In medicine, every choice available is the super duper ultra deluxe spare no expenses package.  I'm betting that none of those workers polishing my car have health insurance.  But if they ever got sick they can go to the hospital and have the latest and greatest technology and drugs available in the United States at their disposal, even if they are unable to pay back a dime.

Medical care is probably the only "necessity" where people think they should be able to get the absolute best available even if they can't pay for it.  Consider the other necessities of life.  Food.  Walk into any supermarket and there are choices galore.  Not everybody can afford the lobster or the filet mignon but if you can't afford it you can always buy something else.  At least you won't go hungry.  Clothing.  We can't all wear Armani, but anybody can buy clothing at Walmart and stay warm.  Shelter.  You have your choice of apartment rentals up to ginormous Beverly Hills mansions.  If you can't afford it you ain't living in a Beverly Hills mansion.  However virtually anybody can find an apartment to live in if they can't afford a house.

Health care is the one industry where everyone demands the best no matter the cost.  Heaven forbid if you should surf the internet and somebody said you should get a PET scan even if your doctor doesn't recommend it.  You will damn well keep nagging the doctor until you get one, or go to another doctor who will.  You read about a procedure that might be considered experimental but a faceless "expert" claims there is a ten percent chance of success.  You'll write to the hospital administrator and threaten a lawsuit if you don't get it.  Heard about a new drug that just might extend your life for another three to six months but costs $20,000 for the treatment?  And you don't have the money for it? There are all sorts of movies extolling the virtues of these patient Davids vs. cost cutting Goliaths.  Of course the movies never say the money that goes to pay for these extremely expensive marginally effective treatments have to come from somebody else, usually you and me in the form of higher insurance premiums and higher taxes.

So next time you go into a car wash, marvel at the smorgasboard of choices available, any levels of waxing, polishing, detailing depending on your desired price point.  There is something for everybody.  That's the capitalistic inspirational shining city on the hill U.S. of A. I know.  Then consider that in medical care everybody demands the same super deluxe top of the line treatments with no incentive to stay healthy and why this country is going broke. With deficits in the trillions of dollars well into the next decade, this egalitarian attitude is quickly transforming our country into the People's Republic of America.  Happy Fourth of July my faithful readers.